PDF(Pubmed)
Abstract：
Despite the recent advances in cancer treatment, the incidence of patients with spinal metastases continues to grow along with the total number of cancer patients. Spinal metastases can significantly impair activities of daily living (ADL) and quality of life (QOL), compared with other types of bone metastases, as they are characterized with severe pain and paralysis caused by skeletal-related events. Reduced ADL can also lead to treatment limitations as certain anticancer agents and radiation therapy are not compatible treatments; thus, leading to a shorter life expectancy. Consequently, maintaining ADLs in patients with spinal metastases is paramount, and spine surgeons have an integral role to play in this regard. However, neurosurgeon, orthopedic and spinal surgeons in Japan do not have a proactive treatment approach to spinal metastases, which may prevent them from providing appropriate treatment when needed (clinical inertia). To overcome such endemic inertia, it is essential for 1) spine surgeons to understand and be more actively involved with patients with musculoskeletal disorders (cancer locomo) and cancer patients; 2) the adoption of a multidisciplinary approach (coordination and meetings not only with the attending oncologist but also with spine surgeons, radiologists, rehabilitation specialists, and other professionals) to preemptive treatment such as medication, radiotherapy, and surgical treatment; and 3) the integration of the latest findings associated with minimally invasive spinal treatments that have expanded the indications for treatment of spinal metastases and improved treatment outcomes. This heralds a new era in the management of spinal metastases.
摘要：
尽管最近在癌症治疗方面取得了进展，脊柱转移患者的发病率随着癌症患者总数的增加而继续增长。脊柱转移可显著损害日常生活活动(ADL)和生活质量(QOL),与其他类型的骨转移相比，因为它们的特征是由骨骼相关事件引起的严重疼痛和瘫痪。ADL降低也可能导致治疗限制，因为某些抗癌剂和放射疗法是不相容的治疗方法；因此，导致预期寿命缩短。因此,维持脊柱转移患者的ADL至关重要，脊柱外科医生在这方面发挥着不可或缺的作用。然而,神经外科医生,日本的骨科和脊柱外科医生对脊柱转移瘤没有积极的治疗方法，这可能会阻止他们在需要时提供适当的治疗（临床惯性）。为了克服这种特有的惯性，至关重要的是1)脊柱外科医生了解并更积极地参与肌肉骨骼疾病(癌症运动)和癌症患者;2)采用多学科方法(协调和会议不仅与主治肿瘤学家，而且与脊柱外科医生,放射科医生,康复专家,和其他专业人士)先发制人的治疗，如药物治疗，放射治疗,和手术治疗；3）整合与微创脊柱治疗相关的最新发现，这些发现扩大了脊柱转移瘤治疗的适应症并改善了治疗结果。这预示着脊柱转移瘤管理的新时代。
